Intramuscular Placement of Birth Control Device: A Multimodality Case and Review

Implantable forms of birth control have been used as a means for convenient and effective medication delivery. Nexplanon® (Merck Sharp & Dohme B.V., Haarlem, the Netherlands) is an implantable birth control device placed in the subcutaneous tissue of the upper medial arm during an in-office procedure. The location of the device is usually confirmed by palpation during a physical exam. In cases where the device is non-palpable, imaging may aid in localization. Implantable birth control devices have a characteristic radiologic appearance, and the location of the device can be confirmed by utilizing ultrasound and/or radiography. Occasionally, sonographic and radiographic studies may have equivocal results necessitating advanced imaging with computed tomography (CT) and/or magnetic resonance imaging (MRI). Subcutaneous location of the device is essential for efficacy and safety. An intramuscular position of the device is inappropriate and may lead to insufficient medication delivery and/or injury to the deep soft tissues. This case reviews the imaging features of a Nexplanon device which had been inappropriately placed into the muscle.